Archived: Margaret House

Updated 5 October 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on the 31 July and 2 August 2017 and was unannounced. The inspection team consisted of three inspectors, one of whom was a pharmacy inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

On this occasion, we did not ask the provider to complete a Provider Information Return (PIR), this was because the inspection of Margaret House had been brought forward due to a number of safeguarding concerns the local authority had received. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Before the inspection we checked the information that we held about the service and the service provider. This included statutory notifications sent to us by the provider about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send us by law. We used all this information to decide which areas to focus on during our inspection.

During our inspection we spoke with 12 people, two visiting relatives, six care staff, the manager, the nominated individual (provider), a member of the management team from Saxon Weald and a manager from the provider’s sister’s service. We reviewed a range of records about people’s care and how the service was managed. These included the care records for 10 people, medicine administration records (MAR), training records, staff files, agency profiles, quality assurance reports, policies and procedures and other records relating to the management of the service.

We also 'pathway tracked' people who received a package of care from Care Sussex Ltd. This is when we followed the care and support a person's received and obtained their views. It was an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

This was the first inspection of the service under the new provider with the CQC.

Updated 5 October 2017

We inspected Margaret House on the 31 July and 2 August 2017 and the inspection was unannounced. The inspection of Margaret House had been brought forward due to a number of safeguarding concerns around the management of medicines.

Care Sussex Ltd provides personal care services to older people in their own homes (flats) who live in Margaret House. People live in an assisted living development within privately owned, self-contained one or two bedroom flats. The building is owned by Saxon Weald and a restaurant is on site along with communal areas for people to participate in a range of activities. The Care Quality Commission was only inspecting the care provided by Care Sussex Ltd and not the accommodation or building maintained by Saxon Weald. On the days of our inspection, 33 people were receiving a package of care from Care Sussex Ltd.

At the time of our inspection, a registered manager was not in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The previous registered manager had left the service in April 2017 and a replacement manager had recently been recruited. On the days of the inspection, they had only been in post four weeks.

The overall rating for Margaret House is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the providers' registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Care Sussex Ltd had been subject to a period of instability. The management team had changed considerably and staff told us they had experienced a turbulent year. The service was experiencing difficulties with recruitment and consequently there was a high use of agency staff. Within recent months, a number of medication errors and missed calls were identified which had led to a number of safeguarding concerns being raised. These safeguarding concerns were subject to on-going reviews at the time of our inspection. Staff were found to not be following procedures and there was a lack of accountability within the staff team. Staff morale was low which heightened a negative and blame culture. The provider was working in partnership with the local safeguarding team to address these concerns and expressed clear commitment to driving improvement. A new manager had been appointed and staff told us that things were beginning to improve. People also felt that the provider was now taking steps to ease their anxiety and distress. One person told us, “I have met the new manager, it has been pretty good since she has been here, and she deals with things pretty quickly.” However, on the days of these inspections, these improvements were not yet embedded or sustained.

Quality assurance processes were not consistently robust in identifying shortfalls with documentation and the provision of care. An overarching action plan was not in place and therefore the provider was unable to monitor any progress being made or have strategic oversight of the actions required to drive improvement. The action plan for the management of medicines had not been reviewed since April 2017 and it was not clear what actions had been completed or were in progress.

Robust risk assessments were not in place and failed to provide sufficient guidance for staff to follow in order for them to provide safe care. The management of diabetes and catheter care was ineffective and placed people at risk of harm. The provider had failed to follow the principles of the Mental Capacity Act 2005 (MCA) and there was a risk that people’s legal rights were not being upheld.

The oversight of ‘Do Not Attempt Resuscitation’ was ineffective and placed people at significant risk of being resuscitated when they were not for resuscitation. The management of medicines was not safe. Allergies were not recorded on people’s medicine administration records (MAR charts), medicine risk assessments had not been reviewed or updated following a medicine error and subsequent safeguarding concern. Risk assessments were not personalised and failed to include information on where medicines were stored in people’s individual flats. Staff had not consistently been signed off as competent to administer medicines.

Care plans were in place and included an overview of the care calls and the tasks required at each care call. However, care plans had not been reviewed in over a year. Internal reviews of people’s package of care had not taken place.

The oversight of people’s nutrition and hydration needs was unclear and contradictory which had the potential to place people at risk. Communication between Care Sussex Ltd and the restaurant on site was not effective in ensuring people’s dietary needs were met. We have identified this as an improvement that needs improvement.

People felt confident in the abilities of permanent staff. One person told us, “I think they are well qualified and trained.” However, people lacked confidence in the skills and abilities of agency staff. Before agency staff worked for Care Sussex Ltd, the provider received a profile of their training. On the first day of the inspection, we identified one agency staff member whereby the provider had not received confirmation of the training they had undertaken. The manager confirmed that moving forward full profiles will be requested and reviewed before agency staff worked for Care Sussex Ltd.

Staffing levels were being maintained with the use of agency staff. Steps were being taken to recruit permanent staff and people confirmed that staff arrived on time to their care call. Staff identified that improvements had been made to the way care calls were allocated which had significantly helped with promoting staff morale. One staff member told us, “We use to have back to back care calls which didn’t help, we were always rushing. But now there are gaps between each care call which means if we run overtime, we don’t have to worry.” Formal complaints were logged and responded to.

During our inspection we found a number breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.